In this study, using the HL7 protocol, we developed patient management system gateway which is composed of 2 parts; message transferring-receiving and sentcncc generating-parsing part. To make the gateway more transplantable, it was developed on the PC operated with Windows OS. To make the gateway more productive, it was developed with Visual Basic 6.0. The database was built into MS SQL. Server which is most optimized on MS Windows NT system environment. This gateway system has the advantage of easy data-exchange capability between the patient management systems of medical facility and the messages transferred can he managed systematically and he transplanted easily into PC base hospital information system.
Hospital Information Systems ; Humans

Primary signet ring cell carcinoma of the urinary bladder is a relatively rare histological variant of mucus-producing adenocarcinoma usually of poor prognosis. We report two cases of primary bladder signet ring carcinoma. The first patient underwent a radical cystectomy with ileal conduit (pT3bN1M0), radiotherapy, and chemotherapy (M-VAC regimen) and subsequently expired 37 months after surgery. The other was initially diagnosed with peritoneal metastasis from the primary bladder signet ring cell carcinoma and was treated with partial cystectomy (pT3bNOM1). Postoperative adjuvant therapy was not done because of patient's refusal.
Adenocarcinoma ; Carcinoma, Signet Ring Cell ; Cystectomy ; Disulfiram ; Humans ; Neoplasm Metastasis ; Prognosis ; Urinary Bladder ; Urinary Diversion

BACKGROUND: It is controversial whether the presence of bullae on the contralateral lung on HRCT plays a role in occurrence of contralateral primary spontaneous pneumothorax. We analyzed the significance of bullae on the contralateral lung and the risk factors associated with contralateral occurrence of primary spontaneous pneumothorax. MATERIAL AND METHOD: Three hundred ninety four patients who were undergone Video.Assisted Thoracoscopic Surgery for primary spontaneous pneumothorax between January 2004 and December 2009 were reviewed. The clinical features, HRCT and treatment of these patients were analyzed retrospectively. RESULT: Twenty eight of 394 patients had contralateral occurrence (7.10%). The average time was 13.06+/-9.79 months. A presence of contralateral bullae of lung on HRCT may not seem to be significant for occurrence of contralateral primary spontaneous pneumothorax (p=0.059). But bullae numbers were much more in contralateral pneumothorax patients (p=0.011). Younger than 20, being underweight (Body Mass Index<18.5 kg/m2) are independent risk factors for contralateral occurrence (odds ratio, 5.075 (1.679~5.339), 2.366 (1.048~5.339) respectively). CONCLUSION: The presence of bullae on the contralateral lung on HRCT was not significantly influenced the occurrence of contralateral primary spontaneous pneumothorax. However, age, body mass index, and the number of bullae were significant factors for the contralateral pneumothorax. We suggest that those high risk patients may require special attentions and general supportive care to prevent occurrence of contralateral primary spontaneous pneumothorax during the follow-up.
Attention ; Blister ; Body Mass Index ; Follow-Up Studies ; Humans ; Lung ; Pneumothorax ; Risk Factors ; Thinness ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

PURPOSE: To evaluate the clinical and radiographic findings of localized foreign body (FB) granulomas onmammograms. MATERIALS AND METHODS: This study involved 13 patients with localized FB granulomas on mammograms;their history of mammoplasty or other plastic procedures was obtained by telephone interviews. Two radiologistsanalyzed the location and morphology of FB granulomas and the presence of associated linear densities orparenchymal distortion on mammograms. Four patients underwent ultrasonography. RESULTS: No patient had a historyof mammoplasty. All 13, however, had a history of plastic procedure, three to 22 (average, 12) years previously,as follows : foreign materials including silicone liquid and oil such as paraffin been injected into the anteriorneck area of nine patients, the infra-auricular area of two, and the nose of two. Multiple small, high-density,flocculent nodules representing FB granulomas were distributed bilaterally in nine patients; they were noted inthe upper inner portion of 11 of 26 breasts. In eight patients, mammograms showed linear opacities suggestingfibrosis. There was no calcification or parenchymal distortion. Though in three cases, the masses were palpable.Ultrasonography revealed several anechoic nodules with posterior enhancement in subcutaneous fatty layers, and inone, 0.2cc of oil droplet had been aspirated under ultrasonographic guidance. CONCLUSION: Localized FB granulomasof the breast could be caused by the migration of FB from cervicofacial areas. Mammography showed characteristicdistribution of upper inner portions, and the findings were similar to those of mild interstitial mammoplasty.
Breast* ; Female ; Foreign Bodies* ; Granuloma ; Granuloma, Foreign-Body* ; Humans ; Interviews as Topic ; Mammaplasty ; Mammography ; Nose ; Paraffin ; Plastics ; Silicones ; Ultrasonography

Despite the high prevalence of chronic dermatitis and the accompanied intractable itch, therapeutics that specifically target itching have low efficacy. Increasing evidence suggests that TLRs contribute to immune activation and neural sensitization; however, their roles in chronic itch remain elusive. Here, we show that the RBL-2H3 mast cell line expresses TLR4 and that treatment with a TLR4 antagonist opposes the LPS dependent increase in mRNA levels of Th2 and innate cytokines. The pathological role of TLR4 activation in itching was studied in neonate rats that developed chronic itch due to neuronal damage after receiving subcutaneous capsaicin injections. Treatment with a TLR4 antagonist protected these rats with chronic itch against scratching behavior and chronic dermatitis.TLR4 antagonist treatment also restored the density of cutaneous nerve fibers and inhibited the histopathological changes that are associated with mast cell activation after capsaicin injection. Additionally, the expression of IL-1β, IL-4, IL-5, IL-10, and IL-13 mRNA in the lesional skin decreased after TLR4 antagonist treatment. Based on these data, we propose that inhibiting TLR4 alleviated itch in a rat model of chronic relapsing itch, and the reduction in the itch was associated with TLR4 signaling in mast cells and nerve fibers.

A large cell neuroendocrine carcinoma of the stomach is extremely rare. We have reviewed the medical records and imaging studies of the four patients that presented with a large cell neuroendocrine carcinomas of the stomach. On a barium study and CT imaging, a gastric large cell neuroendocrine carcinoma is depicted as an ulcerofungating tumor with minimal peritumoral infiltration and metastatic lymphadenopathy in the perigastric area. These findings are similar to findings for advanced gastric cancer, especially Borrmann type II. However, a gastric large cell neuroendocrine carcinoma is highly malignant with a significantly worse prognosis than a usual adenocarcinoma.
Adenocarcinoma ; Barium ; Carcinoma, Neuroendocrine ; Fluoroscopy ; Humans ; Lymphatic Diseases ; Medical Records ; Prognosis ; Stomach ; Stomach Neoplasms ; Tomography, X-Ray Computed

A 42-years-old man was referred to our department due to his hemoptysis. Chest CT showed a cavitary lung lesion in the apical segment of the RUL and an anterior mediastinal mass. The patient underwent wedge resection for the cavitary lesion and complete resection for the mediastinal mass. The pathologic finding was Paragonimus Westermani infestation in both the lung and thymus. The abdomen CT taken postoperatively showed an inflammatory mass involving the transverse colon and a small nodular lesion around the descending colon, which strongly suggested paragonimiasis. Postoperatively, the patient took Praziquantel for 2 days and he was discharged without any complications. There was no evidence of recurrence for the last 2 years.
Abdomen ; Colon, Descending ; Colon, Transverse ; Hemoptysis ; Humans ; Lung ; Mediastinal Diseases ; Paragonimiasis* ; Paragonimus westermani ; Praziquantel ; Recurrence ; Thymus Gland ; Tomography, X-Ray Computed

PURPOSE: To evaluate the efficacy and safety of radiofrequency (RF) ablation for the treatment of small hepato-cellular carcinoma (HCC). MATERIALS AND METHODS: Forty-four patients with 51 HCCs underwent ultrasound guided RF ablation using ex-pandable needle electrodes and a monopolar RF generator. The patients were not considered suitable candidates for surgery or declined this option, and had no history of previous treatment. Mean tumor diameter was 2.5 cm (range, 1.0 -4.0 cm). Therapeutic efficacy was evaluated by means of three-phase helical computed tomography (CT) performed at least one month after the completion of ablation. The recurrence rate was also evaluated by follow-up CT at least four months after treatment. RESULTS: Using RF ablation, complete necrosis was achieved in 48 of 51 tumors (94%). Among 20 patients in whom follow-up CT was performed at least four months after ablation, one (5%) showed marginal recurrence and in another (5%) there was recurrence in remote liver parenchyma. We experienced neither procedure-re-lated mortality nor major complications which required specific treatment. Three minor complications (one small pneumothorax and two cases of intraperitoneal bleeding) occurred, but these disappeared without specific treatment. CONCLUSION: RF ablation using an expandable needle electrode showed a high rate of complete necrosis and a low rate of complications. The technique is therefore considered effective and safe for the local control of small HCCs.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Electrodes ; Follow-Up Studies ; Humans ; Liver ; Mortality ; Necrosis ; Needles ; Pneumothorax ; Recurrence ; Tomography, Spiral Computed ; Ultrasonography

OBJECTIVE: To determine the findings of various focal hepatic lesions at contrast-enhanced gray-scale ultrasound (US) using a coded harmonic angio (CHA) technique and emphasizing lesion characterization. MATERIALS AND METHODS: The study involved 95 patients with 105 focal hepatic lesions, namely 51 hepatocellular carcinomas (HCCs), 22 metastases, 22 hemangiomas, four cases of focal nodular hyperplasia (FNH), and six nontumorous nodules. After the injection of a microbubble contrast agent (SH U 508A), gray-scale harmonic US studies using a CHA technique were performed with a combination of continuous scanning to assess the intratumoral vasculature (vascular imaging) and interval-delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed. RESULTS: At vascular imaging, 69% of HCCs (35/51) showed irregular branching vessels, while in 91% of metastases (20/22) a peripherally stippled pattern was observed. Intratumoral vessels were absent in 95% of hemangiomas (21/22) and all nontumorous lesions (6/6), while in 75% of FNHs (3/4) a spoke-wheel pattern was evident. At acoustic emission imaging, 71% of HCCs (36/51) showed heterogeneous enhancement and 86% (19/22) of metastases showed rim- or flame-like peripheral enhancement during the early phase, with washout occurring in all HCCs and metastases (100%, 73/73) during the late phase. In hemangiomas, enhancement was either peripheral and nodular (19/22, 86%) or persistent and homogeneous (3/22, 14%), and 75% of FNHs (3/4) became isoechoic during the late phase. CONCLUSION: At contrast-enhanced gray-scale US using a CHA technique, a period of continuous scanning depicted the intratumoral vasculature, and interval-delay scanning demonstrated the sequential enhancement pattern. The characteristic findings of various focal hepatic lesions were thus determined.

PURPOSE: The purpose of this study was to determine the factors influencing on the size of thermal lesions after ablation using an expandable radio-frequency needle electrode in porcine liver. MATERIALS AND METHODS: Ablation procedures involved the use of a monopolar radio-frequency generator and 15-G needle electrodes with four and seven retractable hooks (RITA Medical System, Mountain View, Cal.,U.S.A.). The ablation protocol in fresh porcine liver comprised of combinations of varying hook deployment, highest set temperature, and ablation time. Following ablation, the maximum diameter of all thermal lesions was measured on a longitudinal section of the specimen. Ten representive lesions were examined by an experienced pathologist. RESULTS: At 3-cm hook deployment of the needle electrode with four lateral hooks, the size of spherical thermal lesions increased substantially with increases in the highest set temperature and ablation time until 11 minutes. After 11 minutes lesion size remained similar, with a maximum diameter of 3.3 cm. At 2-cm hook deployment, sizes decreased to about 2/3 of those at 3 cm, and at 1-cm hook deployment lesions were oblong. At 3-cm hook deployment of a needle electrode with seven hooks, the size of thermal lesions increased with increasing ablation time until 14 minutes, and the maximum diameter was 4.1 cm. Microscopic examination showed a wide zone of degeneration and focal coagulation necrosis. CONCLUSION: The size of thermal lesions produced by the use of an expandable radio-frequency needle electrode were predictable, varying according to degree of hook deployment, highest set temperature, and ablation time.
Electrodes* ; Liver ; Necrosis ; Needles*